October Links and Review

Every week, my newsletter subscribers get links to some of the goodies that I’ve come across on the internets.

Here were the goodies that my peeps got their learn on from this past August.

If you want to get a copy of my weekend learning goodies every Friday, fill out the form below.  That way you can brag to all your friends about the cool things you’ve learned over the weekend.

Biggest Lesson of the Month

Life ought to focus on creating value, for the people you work with, for others, for the world, for yourself. When you create value, rewards will come.

Quote of the Month

“Common 99% thinking won’t get you uncommon 100% results” ~ MJ Demarco

MJ Demarco is becoming one of my favorite authors, and he inspired the biggest lesson above.

Hike of the Month

A great park in the land of China

I didn’t get much hiking in this past month, namely because I was prepping for my talks in the land of China. However, while in China, my hotel was right next to this really cool park that I walked through frequently. Amazing amalgamation of architecture, flora, and people.

Training

The Trick to a Perfect Rear Foot Elevated Split Squat

My son, Trevor Rappa, gave us a great cue on nailing the rear foot elevated split squat. Perfect for those people who sag into the back leg.

Weight Position During the Squat

Want to more effectively load the legs when you are squatting? Here is one of the most impactful changes I’ve made when coaching squats.

Rehab

Blog: Should We Delay Range of Motion After a Total Shoulder Replacement?

Mike Reinold is a guy who I look to on a lot to influence my post-operative care. In this post, he makes a salient point regarding the early range of motion controversy. The devil is in the details.

Blog: All Gain, No Pain Knee Pain Solution for Lunges and Split Squats

Daddy-O Pops Bill Hartman just killing it with the content, fam. This time around, he discusses how he approaches individuals who get knee pain during split stance activities; a common problem I’ve struggled with in the past. Thank you for helping a son out, pops.

Infographic: Early versus Delayed Rehabilitation After Acute Muscle Injury: No Time to Waste

Yann again killing it with these graphics. Here this time he brings us a study which shows how drastic an impact recovery from an injury can be the sooner you start moving.

Health & Wellness

App: Insight Timer

Want to get into mediation but don’t want to spend the buck on Headspace or Calm? Then Insight Timer is your answer. There are several different styles of meditation available in this completely free app.

I will admit, you have to sift through a lot of crap to find the particular meditations that work for you, but once you find one’s that work, you are golden.

My favorites so far are “The Warrior” by Michelle DuVal and Franko Heke 5 Min Guided Meditation

Let me meditate, set it straight

Blog: New Neuroscience Reveals 2 Rituals That Will Make You More Mindful

Eric Barker’s “Barking Up the Wrong Tree” blog is hands down one of my favorite blogs on the internet. He spends a great deal of time researching multitudes of topics, getting quotes from others, and writing about damn interesting material. This time, he discusses meditation, multiple “yous,” and so much more.

Podcast: Dr. Brandon Alleman on Direct Primary Healthcare (The Paleo Solution)

I’ve been binge listening to Robb Wolf’s podcast as of late (a great thing about vacations), and I found this one to be particularly fascinating. Here Dr. Alleman discusses how he is saving healthcare by using a subscription-based system for his patients. It’s quite fascinating how this system is saving his clients, including small businesses, money. I’d definitely check this one out.

Blog: Decrease Rumination and Stress with Movement

I’m a big time ruminator on things. Something I’ve been trying to work on. Here, my boi Seth Oberst discusses how movement can help reduce the urge to ruminate, and how it’s a much better alternative than being on your phone.

Personal Development

Blog: Imposter Syndrome and the Fitness Industry

Man this hit home for me on many levels. My man Dean Somerset wrote an awesome post on what it feels like to experience imposter syndrome, and how all of us have to start from the bottom. It’s about the process, and continuing to grow the process.

Blog: Decision Making, After the Fact

Read this when you think about being critical of someone, your favorite athlete, you spouse, your friend, making a poor decision.

Productivity Tip

I made one simple change to the way I schedule things that has led to drastic improvements in my productivity. What is that change? Check out the quick hit to find out, fam.

Blog: Definining Authenticity

Seth Godin keeps his blogs simple, concise, yet effective. Here he gives us what authenticity is not, and his example for what it is really hit home for me.

Blog: How Answering One Simple Question Can Keep You on Track for Success

Daddy-O Pops Bill Hartman provides us with a great technique at helping you stay on task with your goals. I definitely plan on using this one.

Routines and Measuring 

Routines are a great way to reduce stress, as less decisions have to be made. In order to be successful at reaching a goal, it helps to track progress. Here is how I combine the two.

Book: The Millionaire Fastlane

This book has really hit me hard and made me think about the way I am approaching finances, making money, and many other things. This book will challenge all your preconceived notions about what to do with your money.

Miscellaneous

Book: Barking Up the Wrong Tree: The Surprising Science Behind Why Everything You Know About Success Is (Mostly) Wrong

Eric Barker is one of my favorite bloggers and I am enjoying his book quite a bit. Do you want to find out if nice guys finish last? Or maybe you want to learn from prison inmates how important trust is. He has so many great nuggets in this book that I’m certain you won’t be disappointed.

Music

Every Noise at Once

This is probably one of the coolest things I have ever seen. Want to hear every music genre that has ever existed, then get a Spotify playlist having music within that genre? Because That is exactly what this site does. Un…be…lievable.

 Royce Da 5’9″ – “The Bar Exam 4” 

[WARNING, EXPLICIT CONTENT] Good…Lord…Listen to this. Royce is by far one of my favorite rappers. Like, in my top 10, pushing to get into my top 5. Here is a dope mixtape he put together where he just expresses his lyricism; many on some of your favorite beats.

So…freakin’…underrated

Some of my favorite include “C Dolores,” “Still Waiting,” “Gov Ball,” and “Chopping Block”

Side note: got to meet Royce at a concert with like 10 people. He really is 5’9″. And he’s a cool cat.

Freddie Gibbs – You Only Live 2wice

[WARNING, EXPLICIT CONTENT] Some call him the modern day 2pac, Gangsta Gibbs himself takes street rap to a whole new level. This joint gets him talking about his time he was in jail overseas. It’s a great mix of some serious stuff with his typical gangsta fare. Freddie is currently one of my favorite modern rappers, so please give him a listen. Crushed Glass and Homesick are my favorite two.

Which goodies did you find useful? Comment below and let me know what you think.

Photo Credits

Aashishji

Dominik Lippe (Lipstar) und Yannic Lippe

Course Notes: PRI Interdisciplinary Integration 2015

A Stellar Symposium

Back in April I had the pleasure of finally attending PRI’s annual symposium, and what an excellent learning experience.

The theme this year was working with high-powered, extension-driven individuals.

The amount of interdisciplinary overlap in each presentation made for a seamless symposium. Common themes included the brain, stress response, HRV, resilience, and drive. These are things altered in individuals who are highly successful, but may come at a cost to body systems.

If you work with business owners, CEOs, high-level athletes and coaches, high level positions, straight-A students, special forces, and supermoms, this symposium was for you.

Or a combination thereof
Or a combination thereof

And let’s face it; we are both in this category!

There were so many pearls in each presentation that I wish I could write, but let’s view the course a-ha’s.

The Wise Words of Ron

Ron Hruska gave four excellent talks at this symposium regarding high performers and occlusion. Let’s dive into the master’s mind.

Enter at your own risk. Shizzzaahhhh
Enter at your own risk. Shizzzaahhhh

People, PRI does not think extension is bad. Extension is a gift that drives us to excel. Individuals who have high self-efficacy must often “over-extend” themselves. This drive often requires system extension.

Extension is a consequence, and probably a necessary adaptation, of success.

If this drive must be reduced to increase function and/or alter symptoms in these individuals, we have to turn down the volume knob.

How can we power down these individuals?

  1. Limit alternate choices – These folks take a wide view of a task
  2. Set boundaries – These folks attribute failure to external factors
  3. Making initial tasks successful – So these folks don’t give up at early failures
  4. Objectively measure improvement – This helps motivate people to continue
  5. Establish rhythmic activity that reflects specific set goals – the higher the goals the more likely the positive change.
PRI, we have a bobsled team
PRI, we have a bobsled team

A Tale of Two Forward Heads

We discussed a lot of attaining neutrality at the OA joint. What does that entail?

A: Both occipital condyles centered in the atlas fossa with unrestricted lateral flexion.

What is needed to have that?

  1. 55-60 degrees of cervical extension.
  2. Equal bilateral first rib rotation position.
  3. Centric occlusion with the anterior teeth guiding protrusive movement and canines guiding lateral movement.
  4. Normal maxillary and mandibular teeth contact.
  5. Ability to nasal breathe.
  6. Alternating pelvic capability.
  7. Visual flexibility.
  8. Normal hearing bilaterally.

Lose any one of these and a forward head posture may occur.

The two types of FHP we see include one with the atlas migrating forward with increased cervical flexion and occipital protraction.

Forward-Head-Posture

 

And one in which the atlas migrates backward on the occiput in which excessive upper cervical flexion coupled with lower cervical/upper thoracic hyperextension.

images

With the former’s case, these individuals have a harder time feeling posterior teeth; a loss of frontal plane. When one loses frontal plane, the individual must attempt to increase anterior guidance via extension. Strategies used to do this include tongue thrusting, bruxism, fingernail biting, mouth breathing, clenching, etc. These strategies are protective in nature as they limit potential stress at the TMJ and OA.

Most of the latter include your bilaterally extended individuals. They retrude the atlas to significantly increase cervical stability. This hyperstability allows for dominant performance in the sagittal plane. These individuals may need more visual interventions.

 

She’s a Wise Woman

Dr. Heidi Wise gave one of my favorite presentations of the symposium. She discussed vision’s role in extension-driven individuals.

Vision is the most dominant sensory modality, as it has the ability to override all other senses to redirect attention. To me, this is why vision is such a powerful way to get someone neutral.

Redirection of attention through the visual system occurs through saccades. These eye movements occur 85% of the time our eyes are being used. This is how the visual system detects a salient stimulus.

If visual processes hold someone in an extension pattern, it may become extremely difficult to near-impossible to overcome.

Here is how we start thinking a visual process may be promoting an extension pattern:

  • Those who cannot inhibit extension with traditional floor-up activity.
  • Late-onset (past puberty) or severe near-sightedness.
  • People with extremely good eyesight.
  • Folks who over-focus on objects straight ahead (people who stare).
  • People who walk with purpose (makes me think of my mom in the mall!).
  • High-energy.
Probably more than just a vision patient.
Probably more than just a vision patient.

If someone over focuses (read: nearsighted), eye exploration is minimized. It becomes much harder to notice change, or salience. This is how the visual system can keep someone stuck in a stress response.

What is needed to see close?

  • Increases in acetylcholine and norepinephrine.
  • Reflexive increase in neck/head muscle tension. More so if one must strain to see.

Do this too long, and we can see unfavorable autonomic, visual, and neuromuscular stress.

And guess what visual field research is showing we better attune to? The right side; more specifically, the right upper visual field.

The PRI goal? We want to restore ambient vision in these individuals to process three planes of visual motion.

Here were some of Heidi’s recommendations for how to do so.

  1. Take breaks from a task to move.
  2. Be aware of surroundings on both sides without looking when walking.
  3. Walk slower than usual.
  4. Look around using your eyes independent of your head.
  5. If nearsighted, take glasses off occasionally and “be OK” with things far away being blurry. Don’t strain to see well.
  6. Have top of computer screens at about eye level. Look far from the screen as often as possible.
  7. Close eyes and visualize a large open area that makes you calm.
  8. Minimize time on small, close screens and keep object far from eyes.
  9. Read books over e-readers and keep the book as far away as visually comfortable.
  10. Emphasize peripheral awareness before and after high attention tasks.
  11. Change variable such as sounds or environment during high attention tasks.
  12. Get away from looking in the mirror at movements.
  13. Change lightbulbs to natural daylight.
heidi
And Heidi’s as well

 

Mental Muscle

Dr. Todd Stull provided a lot of neat neuroscience nuggests.

  • Glia purges our brain of waste during sleep.
  • Strongest memories are tied to emotions; more negative than positive.
  • If the limbic system is too active (such as in a threatening environment), prefrontal cortex activity goes way down. You can’t learn as well.
  • Cranial nerves are extremely important in social interaction. Nonverbal cues from these areas can unconsciously affect autonomics.
  • During adolescence (12-25) the right side of the brain and limbic system develop faster than the left and neocortex. This lateralization is why this time period can be so emotion-driven.
  • Face to face interaction is needed to cultivate the nervous system. This is the problem with social media and texting.
  • Dopamine pathways are very active during adolescence; it’s one of the reasons addictions start during this time.
  • Feelings of being overwhelmed are 6 times more common in those who have had concussions.
  • Rehearse making mistakes and how you will come out of them.

He also provided some great patient interaction nuggets that I hope to liberally steal.

  • Keep your eyes on the individual and tell them “it’s great to see you here.”
  • If you are not doing well on a given day – “I don’t feel good today but we’re going to have a good session.”
  • If you are at odds with a patient – “We’ve seemed to come to a roadblock. Would you agree?”
Ya don't say?
Ya don’t say?

 

Optimizing Mindsets 

My big takeaway from psychologist Dr. Tracy Heller’s talk was mindfulness.

Mindfulness is something I am hoping to get more into in the future. She defines it as being aware of your thoughts, emotions, physical sensations, and actions in the present moment without judging or criticizing yourself or your experience.

It’s a big deal to have this capability. Practicing mindfulness has been shown to reduced cortisol, stress, pain, depression, and anxiety; while also improving memory, sleep, and cognitive function.

The way we build mindfulness is basically letting go. I like the analogy that I heard while using Headspace (a great app if you haven’t used it). Imagine your thoughts and feelings as cars in traffic. Your goal is to just watch the cars pass by, not chase them. You want to be present in the moment, as we want in most of life.

And if you can do this in LA you'll put most Tibetan monks to shame.
And if you can do this in LA you’ll put most Tibetan monks to shame.

One option of practicing this is resonant frequency breathing, in which we perform 4.5-7 breath cycles per minute. Let the body breathe on it’s own and let the air come in; using terms such as “let,” “allow,” and “permit.” These are cues I have been using much more with patients and has made a big difference.

 

Dad’s Part

This was easily my favorite part of the symposium (I may be biased since my Dad gave this talk). Bill Hartman blew it out of the park teaching us how PRI applies at the highest level of performance.

The rules change in the performance realm because the patterns are incredibly powerful, effective, and efficient. In some cases we may want them. A perfect example that Bill gave: Usain Bolt

Rarely does he cross midline when he runs, making him the fastest runner on one leg. Do we want to change that? Probably not.

Performance does not equal health. Gymnasts for example, may need to create pathology to perform at a high level. Some people must utilize passive elements to produce greater outcomes. Usain Bolt runs on one leg. Everyone is a case-by-case basis. N=1 forever.

What must occur in the performance and health realm is stress management. Acute stressors with recovery make us antifragile; prolonged stressors reduce variability as an allostatic adaptation.

If one must constantly perform at a very high level, where will they be on this stress dichotomy? Prolonged stressors = reduced variability, sympathetic dominance, and system extension.

Variability helps us anticipate demand. It helps us become better able to cope with specific environments and recover movement function. The only way we can know if movement variability is present is through assessing the musculoskeletal system

 “The state of the musculoskeletal system is the other end of the brain” ~ Bill Hartman

If stressed or threatened, body systems use default reflexive mechanisms to combat threat. The brainstem is much faster than the cortex. As a consequence, variability can be lost.

Attaining increased prefrontal cortex activity allows us to inhibit our default response and increase variability. That’s why mindfulness increases HRV, and that’s why a 90/90 hip lift can alter body position.

And why juggling gets Bill neutral. Chainsaws preferred.
And why juggling gets Bill neutral. Chainsaws preferred.

To better manage stress, we must train. Training is a progressive desensitization of threatening input to allow an athlete to perform at adaptive potential with optimal variability and without fatigue.

The higher performance level required, the more difficult it becomes to get neutral. This is what happens during functional overreaching. You gain higher performance output during this timeframe because the sympathetic nervous system and HPA axis are on overdrive.

Applying Bill’s principles along the training and rehab continuum, rehab requires neutrality and variability to rebuild a failed stress tolerance. The amount needed in performance realm will depend on how (in)variant one’s sport is.

The Wild World of Combat

Dallas Wood and Zach Nott work with in a military population, and it was fascinating showing how they mitigate the extension necessary for their clientele to perform. They guys collect a lot of data, and the fun factoid was that about 80-90% of their individuals are PEC and bilateral BC (surprise surprise).

They showed us a very cool auditory case. They had a dude with a PEC/BBC presentation with a history of ear trauma and tinnitus. When they blocked his left ear the gentleman was completely neutral.

A viable treatment in probably more cases than you'd think.
A viable treatment in probably more cases than you’d think.

Treatment underwent reducing the tinnitus by implementing a hearing aid that uses various white/pink noises to slowly reduce tinnitus. Not sure exactly how it works, but this was exciting to hear about (ha). I look forward to learning where PRI takes auditory integration.

 

C’est Fini

 So there you have it. I already signed up for next year’s symposium because this one was so much fun. I look forward to more of the consistently fantastic content that PRI provides. Learn on!